The Hospital-List

This is but a brief review of ten hospitals of historic significance. Many hospitals
have had a great impact on the health of our country—from The Queen's Hospital
in Hawaii to Bellevue in New York—and even more around the world. If you fail
to find your own favorite here, don't despair. You can write up a short history of
your institution of choice and send it our way.

1. A temple of Aesculapius

Aesculapius made his debut in Greek literature as the ideal physician, but over time
morphed into a divine status—worshipped as the son of Apollo and a god of healing.
The shrines to Aesculapius were situated near fresh water springs, with beautiful
landscapes and spiritually uplifting locations, and a statue of Aescuplaius as a prominent
feature. In this atmosphere, health could be expected to return to the ailing petitioner.
The patient would bring gifts to the temple such as votive offerings, and offer prayers
and animal sacrifice. Supplicants would enter the snake-filled temple and hope for
a god-given dream, which would be interpreted by the priests and developed into a
therapeutic plan. The plan would generally include rest, a proper diet and recreational
activities. Some therapeutics such as bloodletting or purging were sometimes included.
If a patient got better, it was divine healing; if not, it was the patient's own fault.

2. A Roman valetudinarium

The Romans invested in the care of unique and specific populations. They created what
has been called the precursor to the hospital, a valetudinarium, to care for the empire's
slaves and soldiers. This tradition stretched from the days of Julius Caesar to the
middle ages. Valetudinariums were built within Rome for the care of its increasingly
valuable slaves during economically depressed times. Previously, sick slaves were
often taken to a city square and left to die. Roman soldiers, who viewed death in
battle as an honor, feared the various illnesses that afflicted them off of the battlefield.
Generals were responsible for the well being of their soldiers, and their valetudinariums
were constructed on the northern edges of the empire within fortresses. Roman soldiers
were paid very little, and fringe benefits such as plunder and free health care made
military service much more appealing.

3. The Hôtel Dieu

As the Roman Empire crumbled, the northern areas of it became city-states and approached
the care of their people in different ways. The Parisian Hôtel Dieu was founded
in 651 AD, financed by wealthy individuals hoping to find forgiveness for their transgressions
by donating funds for the housing and care of Paris' poor. As such, the Hôtel
Dieu (God's Hostel) was subject to budgets that ebbed and flowed with the area's economy.
In 1505, the local municipality was placed in control of the Hôtel Dieu, marking
a shift where the care of the poor and sick, previously a religious duty, became a
secular one. The need for this care was great, and by the late 18th century, it was
estimated that 3,500 patients were packed, shoulder to foot, in its 1,200 beds. It
was in this setting that Marie-Francois Xavier Bichat advanced the study of tissues
with his groundbreaking work in histology and pathology. He wrote, “Life is
the sum of forces which resist death.” He was also the spiritual father of
the clinicopathologic school of medicine, which greatly impacted western medicine.

4. The Pantokrator Hospital

In 1136 AD, the few hospitals that did exist were most certainly a place of last resort
for the destitute. Yet in Constantinople, the Pantokrator Hospital was founded as
the chief institution of the medical profession, employing the very best and brightest
physicians around. There was even a medical school with ambitious young doctors trained
there. Built by the Byzantine Emperor John II Komnenos, the Pantokrator (“Lord
Almighty” in Greek) was accompanied by a monastery and a library. The medical
side of the institution housed a gerontochium, or house for the elderly, as well as
a leper sanatorium. Even though it later became a mosque when the Byzantine Empire
fell, much is still known about the Pantokrator due to the existence of its typikon,
or operation rules. These spell out everything from the vegetarian diet that was to
be given to each patient down to how the physicians were expressly forbidden to undertake
any service outside the hospital.

5. The Mansuri Hospital

Completed in 1284 AD in Cairo, the Mansuri Hospital was built by King Al-Mansur, who
earlier was hospitalized himself and as a result vowed to build the greatest hospital
ever. This begs the question of how bad his hospital food must have been. But great
his hospital was, treating upwards of 4,000 patients per day. Islamic hospitals were
called bimaristans, Persian for “place for the ill.” There was a moral
imperative to provide for all those who were afflicted. They turned no one away, even
non-Muslims, and many patients were even given a stipend to compensate for lost work
during their hospitalization. The sole source of revenue for the enormous hospital
budget came from waqfs, pious bequests of the wealthy and ruling class. Of particular
note, the Mansuri Hospital had separate areas, or wards, where patients with different
ailments were treated, and during their stay they were treated to entertainers and
music therapy.

6. The Pennsylvania Hospital

It is with pride that we list the first operating American hospital (even if it was
not officially on American soil yet). In 1751, the charter was granted for the Pennsylvania Hospital. It was
established as a place “to care for the sick-poor and insane who were wandering
the streets of Philadelphia,” a booming city of 15,000 lives.

The idea for a hospital in Pennsylvania was inspired by Dr. Thomas Bond's time spent
at the Hôtel Dieu in Paris, but it did not come to fruition until he enlisted
the political muscle that was Benjamin Franklin. Franklin argued “for the Relief
of such Poor as are afflicted with curable Diseases.” Within a short period,
the Pennsylvania Hospital began admitting patients. Great care was placed into the
design and rules of the facility. Pharmacy and nursing, patient means, and need for
isolation beds were considered. The modern physician would recognize many administrative
items as well, such as strict credentialing, means testing, utilization review and
most importantly, fund raising.

7. Die Allgemeines Krankenhaus

The Hôtel Dieu's continuing influence was also evident in the immense Allgemeines
Krankenhaus, commissioned by Austria's Emperor Joseph II in 1783. The drama contained
within the 1,500 bed “General Hospital” of Vienna was as gripping as
any soap-opera script. In 1847, Ignaz Semmelweis, a physician in the hospital's First
Obstetrical Clinic, reduced the mortality rates of puerperal fever (typically about
20%-25%) to under 1%. He did this by instituting hand washing by physicians and students
with a chlorinated lime solution prior to and between examinations. Semmelweis' determination
to improve the care of his patients was equaled only by his inability to work with
his superiors, and his methods were not adopted at Allgemeines Krankenhaus. Unwilling
or unable to publish his findings in a timely manner, Semmelweis spiraled into exhaustion
and mental illness, dying in a sanatorium just a few years before his methods were
vindicated by the work of Pasteur and Lister. This hospital was also home to the father
of pathology, Rudolf Virchow.

8. St. Mary's Hospital

One hundred years after the founding of Allgemeines Krankenhaus, a tornado ripped
through Rochester, Minn., devastating the town. Inspired by the event, Mother Alfred
of the Sisters of St. Francis approached William Worrall Mayo (father of William and
Charlie Mayo) to staff the hospital the sisters proposed to build. Although he ultimately
agreed, his initial response was that Rochester was too small, and that it would not
be a success. That kind of positive thinking resulted in the construction of St. Mary's
Hospital. The Protestant Mayos and the Catholic sisters worked together to create
a facility to care for patients without regard to religion or sex. St. Mary's was
one of the pivotal centers responsible for the transformation of hospitals, at the
turn of the century, from places where the indigent and extremely sick would go to
die to premiere centers for healing and patient care. The first patient was admitted
in 1889, at a cost of a dollar a day (more for a private room). One important innovation
was the elevator. It was based on a hydraulic system and implemented by Dr. Charlie
Mayo. The water that raised the elevator was released with its descent and pumped
to a tank on the roof, where it provided the water for the toilets.

9. The Johns Hopkins Hospital

Bequeathed by the Baltimore merchant Johns Hopkins, designed by John Shaw Billings
(of New York City public library fame), staffed by several luminary Williams (William
Osler, William Halstead and William Welch), the hospital incorporated state-of-the
art concepts such as ventilation. The hospital became a great site of bedside teaching.
Perhaps it's best to quote Osler himself from Aphorisms, describing what a hospital should be: “The type of school I have always felt
the Hospital should be: a place of refuge for the sick poor of the city—a place
where the best that is known is taught to a group of the best students—a place
where new thought is materialized in research—a school where men are encouraged
to base the art upon the science of medicine—a fountain to which teachers in
every subject would come for inspiration—a place with a hearty welcome to every
practitioner who seeks help—a consulting center for the whole country in cases
of obscurity.”

10. The hospital of the future: 1964

What will be the future of the hospital? Thus was the question asked a half-century
ago, in an era before shortened lengths of stay and outpatient procedures, audits
and alternative care. Futurists of the time suggested many changes in the structure
and function of the hospital. Perhaps it would be an inverted diamond, saving the
grounds for parks and walkways, perhaps under the sea. Maybe patients would be transferred
around the facility in personalized capsules. In the era before ICUs, who would have
predicted the complexity of care we provide to the high-acuity patients now admitted?
Perhaps we are not yet practicing under the sea, or in outer space. But we do walk
around with tiny computers in our hands that can pull up all the knowledge in the
world; patients swallow telephoto capsules to image their GI tracts; we transplant
hearts—and much more. Their fantasies are our reality and the hospital of the
future will likely be different than we ever might expect.

Mr. Bailey and Mr. Bracken are second-year medical students at Mayo Medical School.
Dr. Newman is a hospitalist at Mayo Clinic in Rochester, Minn., and ACP Hospitalist's
editorial advisor and humor columnist.

ACP Hospitalist provides news and information for hospitalists, covering the major issues in the field. All published material, which is covered by copyright, represents the views of the contributor and does not reflect the opinion of the American College of Physicians or any other institution unless clearly stated.